Cath Lab Digest

Tell us about your cath lab.

MD Anderson Cancer Center is the only cancer center that has its own cardiac cath lab. Our work is specifically focused on providing cardiovascular care to cancer patients. A significant percentage of our patients require extensive cardiovascular care in almost all phases of their cancer treatment. Cardiovascular procedures are necessary to evaluate and risk-stratify patients, treat patients with cardiotoxicity during chemotherapy, and ensure their long-term survival after completing therapy.

We have one lab with three registered nurses (RNs) including the manager and one radiologic technologist (RT). Each of us has more than 10 years of experience in the cath lab, with the longest at 16 years, with a combined cath and EP experience of almost 50 years.

What procedures are performed in your cath lab? 

We perform diagnostic catheterizations, endomyocardial biopsy, pericardiocentesis, optical coherence tomography (OCT), fractional flow reserve (FFR) studies, peripheral interventions, and pacemaker and automatic implantable cardioverter defibrillator (AICD) implantations. Outside the acute setting, we perform  FFR-guided percutaneous coronary intervention (PCI); we average about 10-12 diagnostic cases per week. We began doing diagnostic cardiac catheterization in high-risk cancer patients and have progressed to performing OCT and FFR studies, and peripheral interventions. While in the general population thrombocytopenia is a rare occurrence (4:100,000 patients), annually 140,000 patients are diagnosed with hematological malignancies and during cancer therapy will become thrombocytopenic, representing more than 15% of our patients in the cath lab.

While we do not perform emergent revascularization and our lab does not take call, we are equipped to perform emergent interventional procedures should the need arise.

What percentage of your patients is female?

Our female patient percentage is 38% and male patient percentage is 62%.

What percentage of your diagnostic cath patients goes on to have an interventional procedure?

Fifteen to twenty percent undergo interventions. We have decreased the number of stents by using FFR-guided PCI.

Do any of your physicians regularly gain access via the radial artery?

Our interventional cardiologist performs radial access in 20-30% of our cases, especially in patients with thrombocytopenia.

Who manages your cath lab?

Our lab is managed by a registered nurse who is also active in the cath lab.    

Do you have cross-training? Who scrubs, who circulates and who monitors?

All of our staff is cross-trained to perform every role in the cath lab. Our nurses are equally skilled to perform duties outside nursing, including scrubbing, monitoring or operating the x-ray equipment. 

Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab?

No, an RT does not have to be present, as long as a physician credentialed in fluoroscopy is present. 

Which personnel can operate the x-ray equipment (position the II, pan the table, change angles, step on the fluoro pedal) in your cath lab?

Our staff operates the x-ray equipment and our physicians step on fluoroscopy.

How does your cath lab handle radiation protection for physicians and staff?

The institutional physicist has provided an annual in-service to our physicians and staff about radiation safety. Everyone in the cath lab is required to wear a radiation badge that is monitored, and wear protective lead during procedures. The institutional physicist has marked the floors where one could potentially get increased radiation exposure. The physicist is notified about the patients that have received radiation treatment within the last 6 months and if the dose of radiation has exceeded 5000mGy; thus far, this has not occurred. At discharge, we provide our patients with instructions on signs of radiation skin injury.

What are some of the new equipment, devices and products recently introduced at your lab?

We were the second hospital in the state and one of the first in the country to own a St. Jude Medical OCT system. Our work at MD Anderson Cancer Center is focused on risk stratification and perioperative management of cancer patients, and use of the OCT system is an excellent tool for this purpose. We use OCT to evaluate severity of coronary artery disease, stent endothelialization, presence of microthrombi, and plaque structure. We tailor the patient’s antiplatelet therapy to the OCT results and we have started the PROTECT Registry (A Prospective Registry of OpTical CohErenCe Tomography/Cardiac Catheterization Data in a Cancer Population).

Using the pressure wire, we are able to safely defer interventions in cancer patients, avoiding unnecessary stenting and a subsequent need for dual antiplatelet therapy (DAT). Using FFR, we were able to minimize delays in cancer care and decrease the risk of bleeding (patients do not have to be on DAT for an extended period of time), without an increase in major adverse cardiac events (MACE) at one year (per data in the MD Anderson Cancer Center Cardiac Catheterization database).